Frailty among HIV-1 Infected Adults under Antiretroviral Therapy in Indonesia

Abstract

Background: Increasing age of HIV-1 infected population brought about the risk of frailty as comorbidity, whose prevalence is higher in low and middle-income countries (LMICs). Indonesia as an LMIC also bears a major burden of HIV-1 epidemic with a similarly aging population, but the prevalence of frailty and its predictors are unknown. Objectives: To identify the prevalence of frailty and analyze its associated factors, among HIV-1 infected adults under antiretroviral therapy in Indonesia. Methods: A cross-sectional study was conducted among HIV-infected individuals with inclusion criteria of age ≥30 years old and underwent ART for at least 6 months. The main assessment was done using Fried’s frailty phenotype score, which categorizes subjects into non-frail, pre-frail, or frail. Factors associated with frailty were characterized and multiple logistic regression analysis was performed. Results: A total of 164 subjects were recruited; male subjects were 118 (72%), the median age was 40.5 years old, and the median CD4 nadir was 53 cells/μl. Frailty was identified among 90 (54.9%) subjects with 84 (51.2%) identified as pre-frail and 6 (3.7%) as frail, with dominant frailty phenotype was weakness in grip strength. The multivariate model showed that depression was the only factor significantly correlated with pre-frailty and frailty (OR 2.14; 95% CI 1.04-4.43, p=0.036). Conclusion: Frailty is a common occurrence among HIV-infected patients under ART, with depression as an independent predictive factor.

Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia

“…Also in contrast to our study, Bitew et al stated strong correlation between opportunistic infections, depression, and suicidal ideation [41]. Risk of suicide may increase due to severe physical conditions such as muscle wasting, or direct pathogenesis to the CNS via opportunistic infections or HIV-associated neurocognitive disorder (HAND), or vice versa-depression is also predictive of frailty phenotype and HAND [41,[68][69][70]. Opportunistic infections tend to be more severe as CD4 count decrease below 200 cells/μL; however, infections do not always occur in low CD4 state.…”

Prevalence of Frailty and Prefrailty in People With Human Immunodeficiency Virus Aged 50 or Older: A Systematic Review and Meta-Analysis

“…Table 1 summarizes the 26 studies on the prevalence of frailty in PWH aged 50 or older [ 16 , 19 , 24–47 ]. The frailty assessments were conducted between 2003 [ 43 ] and 2018 [ 35 , 40 ]. The prevalence of prefrailty was reported in 22 of the 26 studies.…”

“…The prevalence of prefrailty was reported in 22 of the 26 studies. The size of the cohorts in each study ranged from 27 [ 35 ] to 1016 [ 32 ]. Two studies [ 28 , 41 ] consisted only of male participants, and 2 other studies [ 31 , 46 ] consisted of only female participants, whereas the rest used mixed-gender cohorts with the range of 6.4% [ 19 ] to 50% [ 43 ] female participants.…”

Risk of Falls in HIV-Infected Patients on Antiretroviral Therapy and Its Associated Factors

“…Then, each item was calculated as a score to define the stages of frailty by Fried et al A score of 0 points means the participant is robust or not frail, 1–2 points is considered pre-frail, and 3–5 points is frail. 19 …”

“…Then, each item was calculated as a score to define the stages of frailty by Fried et al A score of 0 points means the participant is robust or not frail, 1-2 points is considered pre-frail, and 3-5 points is frail. 19 The Time Up and Go (TUG) is a tool for screening the risk of falls in inpatient and community settings. In this test, participants are timed while they rise from an armchair (seat height ±46 cm), walk a distance of 3 meters, then turn and walk back to the chair and sit down again.…”